High-deductible plan switch shows little effect on diabetes patients

Most patients with diabetes who joined high-deductible health plans did not experience adverse outcomes related to diabetes, but acute diabetes complications increased among certain vulnerable subgroups, according to the results of a study published recently in JAMA Internal Medicine.

“The clinical implication is that some vulnerable diabetes patients might end up sicker because of joining a high-deductible health plan,” J. Frank Wharam, MB, MCh, BAO, MPH, an internist and associate professor for Harvard Medical School and Harvard Pilgrim Health Care Institute, told Medical Economics. “Clinicians and their teams should pay special attention to, for example, low-income diabetes patients or diabetes patients with other chronic illnesses.”

According to Wharam, little is known about how high-deductible health plans affect important health outcomes.

“Many health interventions, such as medicines or medical devices, cannot be used until there is proof of safety and efficacy. Unfortunately, the same does not happen for health policies,” Wharam said. “High-deductible health plans have already been expanding quickly, and this expansion is expected to accelerate if the Affordable Care Act is replaced. As a society, we need to understand how high-deductible plans affect the health of patients with chronic illnesses.”

To understand the effect of these plans on patients with diabetes, Wharam and collegaues conducted a study using data from a large national health insurer database from January 2003 to December 2012. The study included 12,084 people on a high-deductible health plan aged 12 to 64. Patients were enrolled for 1 year on a low-deductible plan before switching to a high-deductible plan after an employer-mandated switch.

Overall, the increase in out-of-pocket spending was 49.4% for the entire study population compared with control patients who did not transition to a high-deductible plan; this increase was 51.7% for low-income patients, and 67.8% for patients were health savings account eligible.

Next: The need for more tailored plans

Need for more tailored plans

There was no significant change in high-priority primary care visits and disease monitoring tests among the overall patient population. However, the researchers found that visits to high-priority specialists declined by 5.5% in the first year after the plan transition and 7.1% in the second year compared with baseline.

“The implications of the decrease in high-priority specialist visits are not yet clear,” Wharam said. “Although these visits were for important diagnoses, it is unclear whether these visits were truly crucial to patients’ future health or whether the level of decrease would affect health outcomes.”

All patients and low-income patients had delays in outpatient acute diabetes complication visits, data showed. In addition, annual emergency department acute complication visits among patient with high-deductible plans increased by 8% overall and by 21.7% and 15.5% among the low-income and health savings account eligible groups, respectively.

“Our results indicate that more tailored health insurance plans might be needed,” Wharam said. “For example, employers could shift health savings account contributions to their lowest-income workers. In addition, the out-of-pocket costs of highly valuable services, such as urgent care or emergency department visits for potential complications could be reduced.”